Transcript Doctors In Difficulty - South Bristol GP trainers workshop

Saunton Sands 30.3.12
What is a DID
A doctor in training who, for whatever
reason, is struggling to complete
satisfactorily what is required of them to
become an independent general medical
practitioner.
Established or emerging?
Have they been taken on by the trainer as a DID
who isn’t succeeding elsewhere and the
deanery want to re-place in a different setting,
or...
Are you the 1st trainer to suspect they have
developmental problems of some sort
Some experience already in the
room...
Break into 3 groups, each has at least 1
trainer with DIDs experience...
 Discuss what the difficulty was (for the trainer, the
trainee, the practice)
 How was it approached
 What help was available
 How did it turn out
‘Difficulty’ can be of various
types...
 Lack of knowledge
 Inability to apply knowledge in clinical GP
 Poor skills, especially communication
 Attitudinal issues
 Health issues
 Probity issues
Main training issues:
 Defining level of knowledge & skill
 Identifying areas most lacking
 Initial education programme based on these learning
needs but flexible...most immediate needs can
change with time
 Coping with complex medical problems and complex
patients
 Living with uncertainty
Main issues (cont):
 Ensuring pt safety
 Documentation – achievements & progression as well
as anything not up to standard
 Individualising training to maximise potential
 Reaching conclusion re registrar’s competence...fit for
independent practice?
Starting off in the practice...
 Gather info from previous trainers & deanery, how has
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difficulty manifested itself
Make registrar feel welcome & part of team (baggage of
seeming to be failing)
Induction programme – sit in with all doctors, whole
practice needs to be engaged with their training
Setting the scene – shared understanding of expectations
& responsibilities of trainers & registrar – operate in open
honest environment
V.clear ‘rules’ re feedback – make registrar aware trainer
will be giving constant feedback on their performance,
both good & not so good
Getting down to training...
 Main trainer has additional time (offsets more funding)
 Initially all cases discussed before pt leaves – trainer’s
timetable reflects this – more slots blocked
 ‘the devil’s in the detail’...pt discussion takes place at
a different level – probing Qs to test knowledge &
understanding at a deep level – seemingly superficial
answers are challenged & drilled down to ensure
trainer is happy with level of ability
 Detailed checking of knowledge/understanding re
medical conditions, drugs, Rx protocols, guidelines
(NICE, SIGN, BHS, BTS etc)
 Inadequacies revealed incorporated into flexible
learning plan
 Spot problems early & develop culture of talking
about them & using them as trigger for learning
needs
 Ask registrar to keep PUNS & DENS which is shared
 Weekly joint surgeries & frequent viewing of video
consultations – how is registrar applying knowledge &
communicating
 Feedback – on a daily basis
 Make sure good work is praised as well as noting
where improvement is required
 Substandard work or excuses for it not accepted;
likewise behaviour
 Other trainers involved in training schedule – so
educational supervisor has colleagues with whom to
discuss registrar’s progress
 Documentation – be aware of & record comments &
informal feedback from staff & patients
 Training documentation – weekly log but also day to
day recording of good and less good feedback eg
Doctors in Difficulty.doc
Assessing & reaching conclusion
re competence:
 Big responsibility – for safety of patients & future of
registrar
 Detailed documentation of training process &
progress – using in-house methods & e-portfolio
 Triangulation – gathering feedback from multiple
sources – other trainers (own & other practices),
other staff, pts, OOH clinical supervisors, deanery –
small group leader & AD
Conclusion:
 DID training more of a challenge but for some
experienced trainers this is welcomed
 Practice needs to be a learning environment
 Additional time for supervision to enable reliable
assessment & complete thorough documentation
 Support from deanery
So....
If all these factors are in place it is often possible
to nurture a registrar who is struggling and
turn them into one who gets there in the end.